High Blood Pressure: Diagnosis and Treatment

Diagnosis

Sustained and untreated high blood pressure may lead to organ damage, including heart disease, congestive heart failure, stroke, blindness, and kidney disease. Therefore, it is important that hypertension be diagnosed and treated early.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines normal blood pressure as less than 120/80 millimeters of mercury (mmHg). Prehypertension is defined as a blood pressure between 120/80 and 139/89 mmHg. This range signals increased risk for progression to hypertension and requires regular monitoring.

Hypertension is defined as an average blood pressure of 140/90 mmHg or greater, as measured at two or more different office visits. Stage 1 hypertension is defined as a systolic blood pressure measurement (the “top” number in the blood pressure value) of 140 to 159 mmHg and a diastolic measurement (the “bottom” number) of 90 to 99 mmHg. Stage 2 hypertension is defined as a systolic measurement greater than 160 mmHg or a diastolic measurement greater than 100 mmHg. Severe hypertension is defined as a diastolic pressure greater than 120 to 130 mmHg.

Treatment

Goal blood pressure is less than 140/90 mmHg, or less than 130/80 mmHg for individuals with diabetes or chronic kidney disease.

Prehypertension usually does not require drug therapy unless the individual is at high risk for heart disease. Nonetheless, anyone with prehypertension would be wise to consider healthy lifestyle changes and monitor blood pressure at regular intervals.

• Lifestyle modifications are an essential initial step in the treatment of hypertension. These may include a low–sodium, low–fat, vegetarian diet, maintenance of appropriate body weight, smoking cessation, reduction in alcohol use, increased physical activity, and possibly stress reduction (e.g., through meditation or yoga).
  
• If diet and lifestyle modification cannot lower blood pressure to an acceptable level, commonly prescribed medications include diuretics, beta–blockers, angiotensin–converting enzyme (ACE) inhibitors, and calcium channel blockers, alpha–blockers, and vasodilators.
  
  Individuals with inadequate responses to single–drug treatment will require combination therapy. Most patients require at least two drugs to achieve target blood pressure, and the use of three or more drugs is common.
  
• People with hypertension tend to have lower levels of a hormone called melatonin than those with normal blood pressure, and some fail to experience the normal nighttime decrease in blood pressure. In limited studies, melatonin supplements (2.5 milligrams at bedtime) lowered nighttime blood pressure significantly in men with high blood pressure. However, further clinical studies are necessary before melatonin can be recommended to hypertensive patients.